Monday, July 21, 2008

Happy birthday Dad!!!The flight paramedic I worked with this week started his job the year I was born. He has seen patients of all sorts, at all stages in life, with all sorts of background stories. Yet, the story of the patient we flew into the big city, and what she did right before we loaded her onto the helicopter, he told me later really moved him.... something that means a lot considering how hardened he is and how much he has seen. Actually, considering the several shifts I've had with the flight paramedics over the years, I have been surprised at how sensitive they are to their patient's needs while serving in a job that could have the tendency to see them slip into the mindset of a courier transporting inanimate packages. Even in the little things. "You're gonna feel a poke here" is something the lab tech should have said (many times) when she was digging to find a vein; instead, it was the paramedics who were keeping an eye out for the patient in that time. Treatment of a patient like a pincushion is something you never want to see... it is even harder to watch when the patient receiving the bludgeoning had been admitted for treatment of a suicide attempt. But back to this inspiring patient. It was a sweltering day in the city, and I had been regretting trying to dress nicely to impress the paramedics beacuse in my pants and long-sleeved shirt I was doing more sweating than shadowing. I wished we could stay in the air-conditioned ambulance station at the airport but instead when the pagers went off. I was hoping for an exciting scene response trauma call, but no, we had to head to the helicopter to answer yet another boring transfer call. Rachel, a 33-year-old mother of two, was being brought in to the big city to see a specialist for a growth in her throat. It hadn't been biopsied, but it was pretty obvious to everyone that it was the cancer coming back.You see, ten years ago, after a dental procedure, she started having trouble swallowing some foods. She ignored it for a few days because she assumed it was inflammation left over from her root canal, but it didn't go away, and finally looking in the mirror with a flashlight revealed a growth that made her weak at the knees. Her worst fears were confirmed when she was given the diagnosis of cancer.The tumour grew incredibly fast, and she soon lost feeling in her face, control of her facial muscles, and had to soon start eating through a tube. That seemed like a minor inconvenience when she had to have a tube put into her throat because the tumour was blocking her airway. Surgery was attempted, followed by chemotherapy and radiation, which took the pressue off her trachea and allowed her to breathe again, but left her bedridden.Then, miraculously, her strength began to come back, and so did the feeling and control in her face. She soon was talking, sitting up, then standing. Nobody seriously expected the day to come when she would leave the hospital, but she did... walking entirely on her own. Unfortunately, the road to recovery soon came to an end. Three years after that, shortly after the birth of her second son, the cancer relapsed, this time much worse. It had spread to the bones in Rachel's vertebrae, paralyzing her from the waist down. Again, she had to undergo surgery, chemotherapy, and radiation. And, amazingly, against all odds, she again had a complete recovery, more miraculous than the first - all of the feeling and mobility in her legs returned. She could walk again!It would have been nice if it could end there, but the story goes on, and not in the direction anybody would want for her. Earlier this week Rachel was having dinner with her family when she got some food stuck in her throat and started choking. She was unconscious for some time before anyone could revive her, and the preliminary tests suggest that not only was the cancer returning, but she had lost some cognitive function while her brain was deprived of oxygen.Right before we picked her up to take her to the big city for some more tests, a few more results came in. It seemed as though the tumour was growing around some crucial arteries and veins, and that surgery would not be able to reach it. Treatment this time around, if any, would likely be palliative. Despite all of this, she was one of the most genuinely nice people any of us had ever met. She thanked all of the paramedics profusely, and didn't complain about anything. "Thank you for serving me," she said to the paramedic I was shadowing as we took her into the hospital. He replied, "No, you have been the one serving me."

When it comes to life, it seems that sometimes it's the world's greatest people that end up getting dealt the worst hand. I don't know how I would cope if I had to go through everything she had in the past ten years. She truly put a face to courage and grace, and since then I have found myself remembering her every time I think I have it rough with traffic or something else minor in comparison. Like I said, though, the paramedic told me he was also really moved by something she did right before we loaded her onto the helicopter. As we pulled her out of the ambulance, and were readying the aircraft's stretcher support, she did something that made me regret cursing the sun the whole day. She was strapped in to her stretcher, but her arms were free, and she spread them out and looked into the sky. "It is such a beautiful day," she said. "I love the sun!" And, knowing full well that she would likely be on a cancer ward for the next several weeks or months, and that this could be the last time she would be at home, she added aloud with the most beautiful smile on her face, "And who knows when I'll see it again."

Reminds me of a patient I saw about a week ago. Terminal metastatic CA, now too dependent on care to be left in an assisted living home, so they called us to transfer her out of there. She slugged my partner in the face when we moved her against her will onto our cot. Yet I did not reciprocate this anger; rather, was quite upset by the fact that a once cheerful woman had become so unhappy with her life because of illness.

Vitum Statisticus

Vitum Finus Printicus

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*Finus Printicus

Updated 7/07.If you have been my patient, identifying information about you will never be found on this blog. If you do think a story here is about you, I can assure you that is coincidental. After hearing about HIPAA and signing confidentiality forms of my own, and reinforced after I was quite stunned to read the news reports and medical blogging community response to a medical bloggers who have gotten in big doo-doo after accusations of breaching a patient's right to confidentiality in their blogs, I've decided to reaffirm that while my hospital and med-school experiences allow me to get an idea of what happens in medicine, those experiences do not end up here as they actually happened. In order to protect the identity of the patients I interact with, and to protect the opportunity for me to continue blogging, any patient and situational information published here (for example, complaints, diagnoses, age, occupation, definitely names, possibly outcome and heck, even gender) is fictional and has nothing to do with the patients I see. Most accounts written on this blog are inspired by real medical experiences but have been changed to the point that they are entirely fictional; if a post reminds you of an experience you had with a doctor, that is coincidental. I have programmed Blogger to give me a reminder to never compromise the identification of patients that I've seen whenever I am about to write a new post. You wouldn't want your personal info being posted on someone's blog in a way that a reader could figure out that it was you, and you wouldn't want to be entirely open with a physician if you knew s/he was just dying to run to his computer and tell the world about your secrets. You are welcome to read this blog as if the events depicted actually happened, since that's probably more exciting, but the patient encounters you read here never did happen.This blog is not meant to be a substitute for consultation with a qualified medical professional. E-mail addresses I'm provided with through e-mails or comments are never distributed, sold, spammed, or abused by me. Contents are indeed copyright: this means they're the author's property, and you need prior express written consent from the author to do any of these: distributing, broadcasting, copying, copying and pasting, transmitting, altering, selling, presenting, and the like. Especially the like.